Exercise Your Shoulder Pain-free
When assessing the passive range of motion, the examiner instructs the patient to flex and extend his her arm, thereby eliciting signs of discomfort or decreased range of motion. Abduction to 90 degrees, adduction, and internal and external rotation of the shoulder assess range of motion and muscular involvement of shoulder pain. While stabilizing the scapula with one hand, the shoulder should then be externally and internally rotated to evaluate glenohumeral motion.
Nevertheless, like other imaging procedures, MR imaging demonstrates many irrelevant and false-positive abnormalities. Disk bulges, disk herniations, degenerative changes, and even spinal cord impingement, occur in totally asymptomatic individuals, and with increasing frequency with age.22,232425 They are not diagnostic of causes of pain. Similarly, tears of the rotator cuff and other lesions occur in totally asymptomatic subjects, and increasingly with age.26,27 28 They are not diagnostic of the cause of shoulder pain.
Several randomized controlled trials of duloxetine for depression reported significant improvements in a variety of pain symptoms, including back pain, shoulder pain, and headache.96,97,98 II The findings from these and other similar trials have been summarized and subjected to further pooled analyses.99,100,101 I Painful physical symptoms among patients with depression was the primary outcome measure for a randomized placebo-controlled trial of duloxetine.102 In this particular study, subjects who received duloxetine 60 mg daily experienced significant improvements in pain and activity-related pain interference. These clinical improvements occurred independent of changes in depressive symptoms.
At times, patients might develop movement problems secondary to an acute injury while at other times they develop joint mobility problems over time which is more of a chronic nature and is due to increased stress on a particular area, which might eventually result in an injury. Manual physical therapy in the form of joint mobilization and manipulation has been shown to be effective in providing long-lasting relief of pain and movement dysfunction. Furthermore, it improves the mobility of a joint allowing for movement re-education and or compensatory movement patterns. The physical therapist provides joint mobilization by gliding or tractioning (separating) the joint using a variety of specialized techniques. In some cases, the decreased mobility in a non-painful area may be causing the problem in another area. For example, a patient presents with shoulder pain. It appears that the joint is being strained at the end of range for overhead movement. The therapist determines that
Shoulder pain is the second most common musculoske- 142 Once present, shoulder pain may persist indefinitely, at one year.143 Shoulder pain may be due to either intrinsic disorders or to referred pain syndromes although The site and distribution of pain usually provides important diagnostic information. Lateral or anterolateral shoulder pain is often associated with impingement syndromes involving the rotator cuff or with frozen shoulder. Posterior shoulder pain can arise from tendo-nitis of the external rotators but is more generally a reflection of referred cervical pain. Similarly, poorly localized pain, or pain that is referred below the elbow into the forearm of hand, should prompt a search for more central pathology. Cluster analysis of examination findings has revealed three patterns based on range of movement.147 The first includes patients with pain plus severely restricted passive range of glenohumeral movement who are most commonly suffering from frozen shoulder. Other...
Vincent is a 54-year-old artist who has made significant contributions to the world of art in the recent past. About 9 months ago, he was involved in a fight at a local bar and an assailant stabbed him in the left shoulder. Although the injury was deep, he underwent immediate surgery and his shoulder injury was repaired without much problem. He had an uneventful recovery. However, after discharge from the hospital, he continued to suffer from pain in the left shoulder, which slowly started to involve his left arm. He was under the care of his primary care physician who prescribed him various analgesics, physiotherapy, TENS, and even suggested acupuncture. Unfortunately, he failed to respond to all these therapeutic measures. He was then referred to the pain physician who found that Vincent's initial injury had healed well, and noted a few trigger points over his left shoulder which he treated with injections. He yet again failed to respond. He was then started on gabapentin without...
Compared to arthrography and operative findings, the sensitivity and specificity of ultrasound for the detection of rotator cuff tears range from 60 to 100 percent.36 Missing, however, are data that show that such tears are the cause of pain, or that repairing such tears guarantees relief of pain. In orthopedic circles, it has been customary to assume that tears in the rotator cuff seen on ultrasound must be the cause of patients' shoulder pain. The validity of this assumption is fatally challenged when ultrasound demonstrates the same pathology in the contralateral, but asymptomatic, shoulder. Tears are not a surrogate diagnosis for shoulder pain.
The enduring nature of chronic pain means that the duration of treatment effects can only be assessed in long-term studies. Twelve months is often considered to be a prolonged study but, for example, in a study of chronic neck and shoulder pain with delayed recurrence after treatment, follow up for 18-24 months was recom-
Radiation-induced peripheral and cranial nerve injury has been conventionally classified according to the latent period from completion of radiotherapy and the clinical course.2 Acute effects occur during the treatment and mainly consist of self-limited sensory symptoms in the distribution of nervous structures within the field of irradiation. Acute regional pain syndrome noted in up to 3.6 of patients after preoperative radiotherapy for rectal adenocarcinoma9 and acute neuralgic amyotrophy occasionally reported in the setting of radiotherapy for Hodgkin's disease10 may also be considered under this category. Early-delayed effects follow radiotherapy by a few weeks to months and are also at least partially reversible. Examples include brachial plexopathy reported in 1-1.4 of breast cancer patients after a latent period of 1.5-12 months (median 4.5)11,12 and lumbar plexopathy documented in a patient with endocervical carcinoma 4 months after pelvic irradiation.13 The former presents...
When a noxious event occurs, and particularly when that irritation is prolonged, a number of changes occur that include a sensitization of the nerve that travels to that area. Therefore, in the case of tendon pain, while the inflammation is around the tendon and its enveloping structures, the nerve to that region becomes sensitized, excitable, and ultimately contributes to the pain experienced. Therefore, interventions of that nerve can reduce the overall experience of pain. This is best exemplified by supra-scapular nerve blocks. Shanahan and colleagues (2003) describe the results of their study on 83 people with shoulder pain who were randomized to receive either a suprascapular nerve block with bupivicaine and methylprednisolone or subcutaneous saline injection. They found that after 1, 4, and 12 weeks the group that received the suprascapular nerve block showed significant improvement in all pain and disability pain scores measured.
She could be suffering from pain in three different anatomical locations due to three different physiological mechanisms. The pain might be coming from (1) visceral pain from the pelvics and from organs such as uterus, tubes, ovaries, or peritoneum (2) somatic pain from the abdominal wound (3) shoulder pain that is most likely a referred pain from the diaphragm due to distension from the collected CO2 gas during laparoscopy.
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